Greater Blood Pressure Variability Is Associated With Lower Cognitive Performance

Zhou, Tan Lai; Kroon, Abraham A.; Sloten, Thomas T. van; Boxtel, M.P.J. van; Verhey, Frans R.J.; Schram, Miranda T.; Köhler, Sebastian; Stehouwer, Coen D. A.; Henry, Ronald M.A.

doi:10.1161/hypertensionaha.118.12305

Cited by 35 publications

(22 citation statements)

References 40 publications

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“…We recently showed both visit-to-visit and day-to-day BPV were related to clinical progression of Alzheimer's disease [42], although for visit-to-visit BPV this was not replicated in another dementia cohort [43]. In the Maastricht study, a composite score comprising 24h and day-to-day BPV was associated with cognitive performance [44]. The current study adds to the previous work on day-to-day BPV, by providing evidence for the potential underlying mechanism linking BPV and cognition.…”

Section: Discussionmentioning

confidence: 95%

Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population

Heus

Reumers

Have

et al. 2020

JAD

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Background: High visit-to-visit blood pressure variability (BPV) has been associated with cognitive decline and cerebral small vessel disease (cSVD), in particular cerebrovascular lesions. Whether day-today BPV also relates to cSVD has not been investigated. Objective: To investigate the cross-sectional association between day-today BPV and total cSVD MRI burden in older memory clinic patients. Methods: We included outpatients referred to our memory clinic, who underwent cerebral MRI as part of their diagnostic assessment. We determined the validated total cSVD score (ranging from 0-4) by combining four markers of cSVD that were visually rated. Home blood pressure (BP) measurements were performed for one week, twice a day, according to international guidelines. BPV was defined as the within-subject coefficient of variation (CV; standard deviation/mean BP*100). We used multivariable ordinal logistic regression analyses adjusted for age, sex, smoking, diabetes, antihypertensive medication, history of cardiovascular disease, and mean BP. Results: For 82 patients (aged 71.2 ± 7.9 years), mean home BP was 140/79 ± 15/9 mmHg. Dementia and mild cognitive impairment were diagnosed in 46% and 34%, respectively. 78% had one or more markers of cSVD. Systolic CV was associated with cSVD burden (adjusted odds ratio per point increase in CV = 1.29, 95% confidence interval = 1.04-1.60, p = 0.022). There were no differences in diastolic CV and mean BP between the cSVD groups. When we differentiated between morning and evening BP, only evening BPV remained significantly associated with total cSVD burden. Conclusion: Day-today systolic BPV is associated with cSVD burden in memory clinic patients. Future research should indicate whether lowering BPV should be included in BP management in older people with memory complaints.

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Section: Discussionmentioning

confidence: 95%

Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population

Heus

Reumers

Have

et al. 2020

JAD

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“…And no matter how baseline blood pressure was, higher systolic BPV, diastolic BPV, and mean arterial pressure variability were associated with poorer cognition and greater dementia risk. 43 Zhou et al 44 found that SBP and diastolic BPV have different influences on various cognitive domains. First, the larger DBP variability was associated with lower information processing speed and executive function, and significantly correlated with lower memory function.…”

Section: Influence Of Common Cvds On Cognitive Function In the Elderlymentioning

confidence: 99%

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

Zuo

2022

Therapeutic Advances in Chronic Disease

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Both cognitive impairment and cardiovascular diseases have a high incidence in the elderly population, increasing the burden of care and reducing the quality of life. Studies have suggested that cognitive impairment interacts with cardiovascular diseases such as coronary heart disease, abnormal blood pressure, heart failure, and arrhythmia. On one hand, cognitive impairment in the elderly influences the progression and self-management of cardiovascular diseases and increases the risk of cardiovascular-related adverse events. On the other hand, coronary heart disease, heart failure, higher blood pressure variability, orthostatic hypotension, and atrial fibrillation may aggravate cognitive impairment. The role of blood pressure levels on cognition remains controversial. Several shared biological pathways have been proposed as the underlying mechanism for the association. Cardiovascular diseases may lead to cognitive decline even dementia through cerebral perfusion damage, brain structural changes, inflammation, β-amyloid deposition, and neuroendocrine disorders. It is of great significance to study the interaction and put forward effective interventions in an overall perspective to reduce care burden and improve the quality of life of the elderly patients.

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“…This educational classification is comparable with the International Standard Classification of Education (UNESCO, 2011), and results in a score between 1 and 7: (1) unfinished primary school, (2) finished primary school, (3) unfinished low-level secondary education, (4) lower vocational training, (5) advanced vocational training or lower professional education, (6) finished higher professional education or senior general secondary education, and (7) obtained a university degree (Verhage, 1964). Considering the low prevalence of individuals with unfinished primary school (n = 7) and a university degree (n = 31), we made the categorical distinction between low (Verhage scores 1-3), average (4-5), and high education level (6-7;Zhou et al, 2019).…”

Section: Educationmentioning

confidence: 99%

Positive Effects of Education on Cognitive Functioning Depend on Clinical Status and Neuropathological Severity

Jansen

Geerligs

Claassen

et al. 2021

Front. Hum. Neurosci.

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Background: Variability in cognitive functions in healthy and pathological aging is often explained by educational attainment. However, it remains unclear to which extent different disease states alter protective effects of education. We aimed to investigate whether protective effects of education on cognition depend on (1) clinical diagnosis severity, and (2) the neuropathological burden within a diagnosis in a memory clinic setting.Methods: In this cross-sectional study, we included 108 patients with subjective cognitive decline [SCD, median age 71, IQR (66–78), 43% men], 190 with mild cognitive impairment [MCI, median age 78, IQR (73–82), 44% men], and 245 with Alzheimer’s disease dementia (AD) [median age 80, IQR (76–84), 35% men]. We combined visual ratings of hippocampal atrophy, global atrophy, and white matter hyperintensities on MRI into a single neuropathology score. To investigate whether the contribution of education to cognitive performance differed across SCD, MCI, and AD, we employed several multiple linear regression models, stratified by diagnosis and adjusted for age, sex, and neurodegeneration. We re-ran each model with an additional interaction term to investigate whether these effects were influenced by neuropathological burden for each diagnostic group separately. False discovery rate (FDR) corrections for multiple comparisons were applied.Results: We observed significant positive associations between education and performance for global cognition and executive functions (all adjusted p-values < 0.05). As diagnosis became more severe, however, the strength of these associations decreased (all adjusted p-values < 0.05). Education related to episodic memory only at relatively lower levels of neuropathology in SCD (β = −0.23, uncorrected p = 0.02), whereas education related to episodic memory in those with higher levels of neuropathology in MCI (β = 0.15, uncorrected p = 0.04). However, these interaction effects did not survive FDR-corrections.Conclusions: Altogether, our results demonstrated that positive effects of education on cognitive functioning reduce with diagnosis severity, but the role of neuropathological burden within a particular diagnosis was small and warrants further investigation. Future studies may further unravel the extent to which different dimensions of an individual’s disease severity contribute to the waxing and waning of protective effects in cognitive aging.

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Greater Blood Pressure Variability Is Associated With Lower Cognitive Performance

Cited by 35 publications

References 40 publications

Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population

Day-to-Day Home Blood Pressure Variability is Associated with Cerebral Small Vessel Disease Burden in a Memory Clinic Population

The interaction and pathogenesis between cognitive impairment and common cardiovascular diseases in the elderly

Positive Effects of Education on Cognitive Functioning Depend on Clinical Status and Neuropathological Severity

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